Insomnia is like a thief in the night, robbing millions — especially those older than 60 — of much-needed restorative sleep.
The causes of insomnia are many, and they increase in number and severity as people age. Yet the problem is often overlooked during checkups, which not only diminishes the quality of an older person's life but may also cause or aggravate physical and emotional disorders, including symptoms of cognitive loss.
Most everyone experiences episodic insomnia, a night during which the body seems to have forgotten how to sleep a requisite number of hours, if at all. As distressing as that may seem at the time, it pales in comparison to the effects on people for whom insomnia — difficulty falling asleep, staying asleep or awakening much too early — is a nightly affair.
A 1995 National Institute on Aging survey of more than 9,000 people 65 and older revealed that 28 percent had problems falling asleep and 42 percent reported difficulty with both falling asleep and staying asleep. The numbers affected are likely to be much larger now that millions spend their presleep hours looking at electronic screens that can disrupt the body's biological rhythms.
Insomnia, Dr. Alon Y. Avidan says, "is a symptom, not a diagnosis" that can be a clue to an underlying and often treatable health problem and, when it persists, should be taken seriously. Avidan is director of the sleep clinic at the University of California, Los Angeles, David Geffen School of Medicine.
So-called transient insomnia that lasts less than a month may result from a temporary problem at work or an acute illness; short-term insomnia lasting one to six months may stem from a personal financial crisis or loss of a loved one. When insomnia becomes chronic, lasting six months or longer, it can wreak serious physical, emotional and social havoc.
In addition to excessive daytime sleepiness, which can be dangerous, Avidan says chronic insomnia "may result in disturbed intellect, impaired cognition, confusion, psychomotor retardation or increased risk for injury." It is often accompanied by depression.
There are two types of insomnia. Primary insomnia results from a problem that occurs only or mainly during sleep, like obstructive sleep apnea or restless leg syndrome.
The other, more common type of insomnia is secondary to an underlying medical or psychiatric problem; the side effects of medications; behavioral factors like ill-timed exposure to caffeine; or environmental disturbances like excessive noise or light in the bedroom.
Among the many medical conditions that can cause insomnia are heart failure, gastroesophageal reflux, lung disease, arthritis and Alzheimer's disease. Treating the underlying condition often relieves the insomnia.
Nonmedical causes of insomnia can often be treated by practicing "good sleep hygiene": limiting naps to less than 30 minutes a day, preferably early in the afternoon; avoiding stimulants and sedatives; avoiding heavy meals and minimizing liquids within two to three hours of bedtime; getting moderate exercise daily, preferably in the morning or early afternoon; maximizing exposure to bright light during the day; creating comfortable sleep conditions; and going to bed only when you feel sleepy.
If you still can't fall asleep within about 20 minutes in bed, experts recommend leaving the bedroom and doing something relaxing, like reading a book (one printed on paper), and returning to bed when you feel sleepy.
For those who still need help with insomnia, cognitive behavioral therapy has proved most effective in clinical trials.
Sleeping pills can be problematic, but over-the-counter remedies like melatonin or valerian, which have more anecdotal evidence than research to attest to their efficacy, are available.
There may also be some useful dietary aids, like bananas, cherries, kiwis, oatmeal, milk and chamomile tea, though evidence for these is also primarily anecdotal.